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530 LORING AVE - BUILDING INSPECTION
The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code,780 CMR SALEM q Revised Mar Z077 1 Building Permit Application To Construct,Repair,Renovate Or Demolish a �l One-or Two-Family Dwelling This Section For Official Use Only Building Permit Numb Date lied: I V 1 Building Official(Print Name) 91 Date - SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 30 L,gA1AAG' A'SsR LE-rnM4. Lta Is this an accepted street?yes_ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(R) 1.5 Building Setbacks(k) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yesO SECTION 2: PROPERTY OWNERSHIP` 2.1 Owner'of Record: 1)42,0041Al &douPINC �4,161h RX e91470 Name(Print) City,State,ZIP 'Koo zaogt" !??r'7413646 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(cheek all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Altemtion(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ I Other ❑ Specify: Brief Description of Proposed Work : F SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only, Labor and Materials 1.Building $ 1. Budding Permit Fee:$ Indicate how fee is determined: Cl Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing S 2. Other Fees: $ 4.Mechanical (IiVAC) $ List: 5.Mechanical (Fire $ Su ression) Total All Fees:$ Check No. - Check Amount: Cash Amount: 6.Total Project Cost: $ S.00 C 0, 0 Paid in Full 0 Outstanding Balance Due:. SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) ke it AVX719.Q SDSA CoNSTAUC't 1O1V ZAlC— License Number Expiration Date Name of CSL Holder A List CSL Type(see below) 7Bari .14or Type Description No.and Street /�E.FGt/ /11i2 0/9fS U Unrestricted(Buildingsu to 35,000 cu.ft. R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 2 I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) he ��i�7�2 t 5/8�7nIS R S—�c3 r'nn.rTQ Ue.7't nN 1N L HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 76i1a6K wrloc. No.and Street 7�Z`S)4�Y Email address A_UO"LY IAA O trL/�— City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes ..........E3, No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize \t L C'Co ?'t"CT I w" to act on my behalf,in all matters relative to work authorized by this building permit application.3t A C'0 � -T'ZeA PC)e—M va Dv M w a'.�'lb—1.q Print Owner's Name(Electronic Signature) n Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. �U.ne/l� r l.r i � f /oolq S'o5A -9o-t3 Print Owner's oTWMrized Agent's Name(Electronic Signature) Date NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dns 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basemenUattics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"maybe substituted for"Total Project Cost' ACORD CERTIFICATE OF LIABILITY INSURANCE 05/15/2 3' PRODUCER (978) 745-6464 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Rose Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 66 Loring Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 958 Salem MA 01970- INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:WESTERN WORLD INSURANCE C Victor Sosa Construction Inc INSURER B:Travelers 7 Bailey Avenue INSURER C: NSURER D: IBeverly MA 01915- INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPEOF INSURANCE POLICY NUMBER DATE MMIDDIYY DATE MM/DD/YY LIMITS A GENERAL LIABILITY NPP8114585 03/05/2013 03/05/2014 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea RENTED $ 50,000 OLAIM$MADE OOCCUR / / / / MED EXP(My one arson) $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 POLICY X JE 0 LOC AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS / / / / BODILY INJURY SCHEDULED AUTOS (Per parson) $ HIRED AUTOS / / / / BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO / / / / OTHER THAN FA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY / / / / EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE / / / / $ RETENTION $ s B WORKERS COMPENSATION AND 4201P74A 04/20/2013 04/20/2014 X 11 TORVLIAMRS I I ER EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? / / / / E.L.DISEASE-EA EMPLOYEE 500,000 If yes,describe under SPECIAL PROVISIONS W. EL.DISEASE-POLICY LIMIT $ 100,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLEWEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 030 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT City Of Salem FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZE PRESENTATIVE ACORD 25(2001/08) ©ACORD CORPORATION 1988 INS025(=B).m Page 1 of 2 1 -Department of Public Safety � Massachusetts 1 Board of Building Regulations and Standards Construction Supen isur SpecialtN License: CSSL-099488 A I-r V �F VICTOR SOS, Grp, 7 BAILEAVBMJE- Y BEVERLY hjA O1s91 P a i h a` Expiration commissioner 02,14,2014 ' Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration v _ Registration: 146782 Type: Private Corporation Expiration: 5/1 812 01 5 Tr# 237653 VICTOR SOSA CONSTRUCTION INC VICTOR SOSA 7 BAILEY AVE. BEVERLY, MA 01915 x Update Address and return card.Mark reason for change. SCAT 0 20m-0s11 Address Renewal Employment Lost Card tpariznearreoeull�VP/llr:wac�a�elTa = i-\ Office of Consumer Affairs& Business Regulation i License or registration valid for individul use only -, OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to::egis r-14 tratlon 6782 Type Office of Consumer Affairs and Business Regulation xpiration 5/18/2015 Private Corporabc 1 10 Park Plaza-Suite 5170 Boston,MA 02116 VICTOR SOSA CONSTRUCTION.INO. t L � VICTOR SOSA 7 BAILEY AVE. 7{ BEVERLY, MA 01915 - Undersecretary Not valid without signature VICTOR SOSA CONSTRUCTION INC. Lic. # 117227 P.O. Box 197 o BEVERLY, MA 01915 Fax: 978 927-4762 a Cell: 978 265-7432 Proposal Page No. of Pages Proposal Submitted to Phone Date THE DRUMLIN GROUP _ __ 3l9/20 Street lob Name 13 600 LORING AVE City,State,And Zip Code Job Location SALEM MA 01970 _ _ 530 LORING AVE SALEM MA 01970 _ Architect Date of Plans lob Phone We Weby u.bmia spedfvaems and es imates ler _Remove rocks to one side of the roof and remove old rubber. _ --- Install new 060 EPDM . _ Install new flashing around all vents, drain, pitch pan and pipes_________ i Install new rubber around elevator and elevator roof. Apply all rocks back on place. Remove and clean all trash . All work guaranteed for 15 years. r WE PROPOSE hereby to furnish material and laborcemplete in accordance with above specifications,for the sum L._._ dollars($ 25.000.00) Payment to be made as follows: All material is guaranteed to be as specified,all wort to be completed in a substantial Authorized workmanlike manner according to specifications submitted,per standard practices.Any Signature '�— alteration or d"knion from above specifications Involving eats costs will be executed only upon written orders,and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control.Owners to carry fire,tornado and other necessary insurance.Our workers are fully covered by Workman's compensation insurance. Note This proposal may Pe withdrawn by on if nor accepted within_days IACCEPTANCE Of PROPOSAL meamyeprices,sPecificationsandconditions are satisfactory and are hereby accepted.You arc authorized to do the work as specified Payment will be made as outline above. Signature Date of Acceptance: Signature tv r CITY OF &U.EN[, .L%'L-1SSACHUSETTS • BCIIDING DEPARTNC&NT • ' 120 WASHINGTON STREET,Yo FLOOR 'ILL (978)745-9595 FAX(978) 740-9946 KI'%IBERLF-Y DRISCOLL LfAYOR THOI.tAs ST.P>ERRH DIRECTOR OF PUBLIC PROPERTY/BVI DING COMMISSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Busim-ssOrganizatiordIndividual): 6114rD.P 5'oS.9 PDtuS?iQUGT ION JT NG Address: 7Ao/1ey 4zlir _ City/State/Zim 4JCUF.QLY /!) ,Olt?iS` Phone a: 97ft 94.f74.52 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with,7 4. ❑ 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the subcontractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.; 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity, workers'comp.insurance. g, ❑ Building addition (No workers'comp. insurance S. ❑ We are a corporation and its 10 El Electrical repairs or additions officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL I I.❑Plumbing repairs or additions myself.[No workers'comp. c. 152.$1(4),and we have no 12.®-Roof repairs insurance required.]t employees.(No workers' 13.0 Other, COMP.insurance required.] •Any applicant that checks has el most also fill out the section below showing their worker'compensation policy information. a Ifo neownr,who submit this aflidavh indicating they are doing all work and then hire outside camrmgors must submit a new anidavit indicting such Tanimurs,that check this box most anachall an additional ahem slowing the home of the cub-eontrxtws and thek woham'comp.polity infenrtaaon. t am as employer that is providing workers'compensadon insurance for my employee& Below is the ponty and job site information. q Insurance Company?lame: l tQ.4 6 S Policy N or Self-his.Lie.M 419 Df P 77 A Expiration Date: A/204 0 I� Job Site Address: 5-30 1eRJy/,-4l/K City/State✓Zip:5ALEYK rM4ofg112 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations or the DIA for insurance coverage verification. t do/sereby eerrlf�yunder the pains and penalties of perjury that the its adon provided above is true and correct SiLnattire: A PhoncX: 07,?2fst7k22 . Official use only. Do not write in this area,to he completed by city or town o fcW City or Town: Permit(License k Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person• Phone M CITY OF S.U.E.N1, iNLksSACHusETrs • BL•II.DLNG DEPaR1'!*1E2%T • 130 WASHLIIGTON STREET,3w FLOOR ° TEL (978) 745-9595 Fax(978) 740-9846 KI.,iBERLEY DRISCOLL MAYOR THontAS ST.PtERRE DmcroR OF PUBLIC PROPERTY/BuUMING CONMISSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit# is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will be transported by: ill eh t S c�s A 7 R D a;r (name of hauler) The debris will be disposed of in : d'EAQ010 Y T�2ANSGQ (name of facility) 3D /=oRGS r A5413o04 MAR (address of facility) signature of permit applicant date JcbriwfTJa: The Drumlin Group 600 Loring Avenue Salem, MA 01970 May 22, 2013 Inspectional Services City of Salem 120 Washington Street Salem, Ma 01970 Re: 530 Loring Avenue, Salem Dear Sir or Madam: We manage the Contemporary Condominium Trust which operates the office building at 530 Loring Avenue in Salem, Ma. The Trustees of the Condominium have authorized us to hire Victor Sosa Construction, Inc. of Beverly to install a new roof on the building. If you have any additional questions, please call me. 2rk you, David Hark C6mmercial Real Estate Sales • Leasing • Property Management • Consulting (978) 741-3696 9 Fax (978) 745-1223 info@drumlingroup.com